Chapter 23

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					Chapter 23 Infections
In this chapter, common infections are reviewed, including urinary tract infections, prostatitis, influenza, pneumonia, tuberculosis, vaginitis, herpes zoster, and scabies. Display 23-3 offers a discussion of control of a scabies outbreak in a long-term care facility.

SIGNIFICANT DISPLAYS, TABLES, AND FIGURES
Possible Signs of Infection in the Elderly (Display 23-1) Age and Severity of Pneumonia (Display 23-2) Control of a Scabies Outbreak in a Long-Term Care Facility (Display 23-3) Symptoms That Can Develop Years After HIV Has Invaded the Body (Display 23-4)

STUDENT OBJECTIVES
After reading this chapter, the student should be able to: 1. Describe unique features of the common infections of older adults.

LECTURE OUTLINE
INTRODUCTION • • Chapter 21 described changes to the immune system that increase the risk for infection. This chapter reviews infections common in older adults. Infections have more profound effects in elders as compared to other age groups. In addition, the elderly can have atypical symptoms. Preventing infections, identifying them early when they develop, and assuring adequate treatment are important gerontological nursing considerations. URINARY TRACT INFECTIONS • UTIs are the most common infection of the elderly; they increase in prevalence with age. Organisms primarily responsible are Escherichia coli in women and Proteus species in men. Improper hygienic practices, catheters, dehydration, and debilitating conditions contribute to UTIs also. • • • Review symptoms and treatment of UTI. Emphasize that fever can present differently. Severe UTIs leading to septicemia occur more frequently in the aged.

PROSTATITIS This is the most common UTI among older men. Most are bacterial in origin.

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Review symptoms and treatment. Although acute prostatitis responds well to antibiotic therapy, chronic prostatitis is more difficult to treat.

PNEUMONIA • Pneumonia, especially bronchopneumonia, is one of the leading causes of death in the elderly. Review the factors that contribute to pneumonia’s high incidence (e.g., age-related changes to respiratory system, high incidence of debilitating conditions, hospitalization). • • Pneumococcal pneumonia is the most common type. Reinforce that signs and symptoms can be altered in the elderly, such as: Less severe chest pain Lower fevers Restlessness, confusion, and behavioral changes can be primary symptoms • Pneumococcal vaccines are recommended for the elderly. Although the duration of protection from the vaccine is uncertain, CDC recommends a single vaccination, so nurses should document the administration of the vaccine. INFLUENZA • • • Influenza is serious in the elderly and most deaths from this infection occur in the aged. Influenza A is the most frequent cause of serious illness and death. Review symptoms and treatment. Preventive measures include annual influenza vaccination, daily vitamin and mineral supplements, and avoiding people with respiratory infections. TUBERCULOSIS • • • • • • • Most cases of TB in elderly are related to a reactivation of an earlier infection. Atypical symptoms can delay diagnosis; review symptoms. A two-step Mantoux test is recommended for elders due to high incidence of false negatives. Review treatment. Side effects of medications used to treat the disease can have special implications for the elderly. Discuss the possible psychosocial implications for elders diagnosed with TB.

VAGINITIS Age-related changes (e.g., thinning of vaginal epithelium, alkaline secretions, altered flora) predispose women to high risk for vaginitis in late life. Review symptoms and treatment. Emphasize the importance of good hygienic practices.

HERPES ZOSTER • • • • • • • • • Herpes zoster is usually caused by a reactivation of the latent varicella virus in the dorsal root ganglia. Review symptoms and treatment. Older adults are more likely to experience postherpetic neuralgia.

SCABIES Scabies is a highly contagious skin infection caused by a mite. Review symptoms and treatment. Discuss the case study in Display 23-3.

HIV AND AIDS About 10% of cases occur in persons over age 65. HIV and AIDS can be misdiagnosed due to low index of suspicion in this age group. Discuss the importance of taking a careful sexual history and educating older adults who are having sex with new partners to use protection. Review symptoms and treatment. Discuss psychosocial challenges that may be present for elders with HIV and AIDS. ANTIBIOTIC RESISTANT MICROORGANISMS • • MRSA: Review the evolution of this infection and its current treatment. VRE: Discuss high risk groups and treatments.

CLASSROOM TEACHING-LEARNING ACTIVITIES
1. Discuss factors other than age-related physical changes that contribute to elders’ high risk of infections. 2. Review the health records of several patients to determine: a. Whether they have a history of an infection b. Symptoms that indicated they had infections c. Measures used to prevent and manage infections other than antibiotics 3. Discuss reasons for Americans’ past high reliance on antibiotics and reasons that this attitude now is changing.

GUIDELINES FOR EVALUATING CRITICAL THINKING EXERCISES
1. • • Good nutrition, daily vitamin/mineral supplement Regular exercise

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Immunizations Stress management Importance of assertiveness, trust, continued psychological growth Careful use of antibiotics

2. Health professionals may believe this to be an infection of younger people and not screen elders for it; elderly people may be reluctant to admit history that could expose them to risk. 3. • • Caregivers, visitors, and others exposed to residents could spread it to others; could have high mortality rate Residents could be quarantined; visitors could wear masks


				
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